Pleurodesis

Pleurodesis is a procedure that closes the space between the two thin layers around your lungs (pleural space). You may need this if you keep getting lung collapses or pleural effusions (extra fluid around your lungs). During this procedure, your healthcare provider will use one of two main methods to make the two pleural layers stick together. This seals the space so air or fluid can’t collect anymore.

Typically, your body keeps a small amount of fluid between your pleural layers to help your lungs move when you breathe. But if too much air or fluid builds up there, your lungs can’t work as well. You become short of breath. Pleurodesis can help prevent extra fluid buildup around your lungs.

Your provider will suggest a method for this procedure based on your condition and overall health. They may use a mechanical or chemical method.

Mechanical pleurodesis

This method uses gauze or a special tool to gently scrape the pleural surfaces to irritate them. They stick together as they heal. Providers use it for people who have a repeated collapsed lung. During a surgical pleurodesis, a provider can also fix the source of the problem. Common methods include:

• VATS pleurodesis: A type of video-assisted thoracic surgery (VATS), which uses small cuts for thin tool access
• Thoracotomy: A larger cut between your ribs to access your lungs

Chemical pleurodesis

This method uses medicine to irritate your pleural layers so they stick together as they heal. It works well for people who have pleural effusions from lung, breast or ovarian cancers. You may also have the chemical type of procedure if you have stubborn chest fluid from kidney problems (nephrotic syndrome), heart failure or repeated lung collapse.

Methods include:

• Talc pleurodesis: The most common and effective medicine for this approach
• Doxycycline pleurodesis: Another medicine a provider can use if talc isn’t right for you

How should I prepare for this procedure?

Your healthcare provider will tell you exactly how to get ready for pleurodesis. In general, you can expect to:

• Get an X-ray and/or a CAT scan of your chest.
• Tell your provider about your medical conditions and medicines (including supplements) you take.
• Let your team know about any allergies you have.
• Stop taking certain medicines on a specific day or time if your provider tells you to.
• Follow any instructions about eating and drinking.
• Wear comfortable, loose clothes.

What happens during pleurodesis?

The steps depend on the method your healthcare provider uses. A pleurodesis procedure can take anywhere from 30 minutes to a few hours.

During chemical pleurodesis, a provider will:

1. Give you local anesthesia and sometimes light sedation to prevent pain and keep you comfortable.
2. Put in a chest tube.
3. Drain the fluid or air around your lungs.
4. Put talc or another medicine into the space around your lungs through a chest tube (or by spraying it through a surgical opening). You may need to change positions to help the medicine cover the area.

During pleurodesis surgery (mechanical method), a provider will:

1. Give you general anesthesia so you’re fully asleep.
2. Make one or more small cuts (for VATS) or a larger cut between ribs to access your chest.
3. Drain the fluid or air around your lung, partly collapsing your lung.
4. Gently rub gauze or a special tool to irritate the layer around your lung.
5. Expand your lung to make sure the layers around your lung seal to each other.
6. Use a chest tube to drain any air or fluid left in your chest.

What are the potential benefits and risks of this procedure?

Pleurodesis can help you breathe easier, reduce pressure in your chest and improve your day-to-day comfort. Talc pleurodesis is successful for at least 8 out of 10 people.

Sometimes, the procedure doesn’t work as well. This can happen if your lung can’t fully expand because of scars or long-term drainage of fluid or air that keeps your lung from opening back up.

Most people do well with pleurodesis, but risks from the procedure may include:

• Pain in your chest
• Infection
• Shortness of breath
• Collapsed lung
• Bleeding around your lung
• Rarely, severe breathing problems, like fluid inside your lungs or trouble getting enough oxygen

What happens after this procedure?

Your healthcare team will watch you closely and prescribe medicine for pain. Most people have a chest tube for a short time so air and fluid can drain and the lung can stay fully expanded. Your healthcare provider will check chest X-rays and drainage amounts daily. They’ll take out the chest tube once your lung is fully open and only a small amount of fluid is coming out.

For people with pleural effusions from cancer, overall life expectancy depends on the type and stage of cancer and the treatments available. This procedure doesn’t treat cancer, but it can improve your breathing and comfort. Some studies show that people who have pleurodesis may have fewer complications and hospital stays related to the underlying disease than people who don’t get the procedure.

What is the recovery time?

You’ll stay in the hospital for a few days after pleurodesis so your team can watch your breathing, manage pain and make sure your lung stays fully expanded. Once you get home, take it easy for a few weeks. It’s normal to feel sore when you breathe or move. Your care team will give you instructions on pain medicine, activity and how to care for the area where the chest tube was.

Follow-up visits

You’ll need a follow-up visit and a chest X-ray four to six weeks after either type of procedure. This helps make sure your lung is still expanded and that no new fluid has built up. This visit also gives you a chance to talk about how you’re feeling and ask questions.

When should I call my healthcare provider?

Contact your healthcare provider if you have:

• Pain in your chest that’s getting worse
• Swelling, redness, leaking fluid or warmth where the chest tube was
• Trouble breathing
• Fever or chills